Changing Etiological Patterns of Pediatric Meningitis: A Three-Year Experience from a Tertiary Pediatric Emergency Hospital in Romania

Background and Objectives: Pediatric meningitis remains a major diagnostic and therapeutic emergency because clinical presentation may be nonspecific and early etiological distinction directly influences treatment, infection control, and epidemiological surveillance. Although bacterial meningitis has traditionally been emphasized because of its severity, the wider use of rapid molecular methods has increased the detection of viral etiologies. This study aimed to evaluate the etiological distribution of confirmed pediatric meningitis episodes and to assess temporal, age-related, and sex-associated patterns, with particular attention to the observed shift from bacterial toward viral meningitis. Materials and Methods: A retrospective single-center analysis was performed using microbiological data from suspected meningitis episodes investigated between 2023 and 2025 at the “Louis Țurcanu” Emergency Hospital for Children, Timișoara. Confirmed episodes were classified as bacterial, viral, or fungal according to the identified etiological agent. The distribution of suspected and confirmed episodes, annual etiological patterns, age-group differences, sex-associated variation, and identified pathogens were assessed using descriptive statistics and trend analysis. Results: Among 641 suspected episodes, 58 were microbiologically confirmed, corresponding to an overall positivity rate of 9.05%. Viral meningitis was the most frequent etiology, accounting for 30 episodes (51.72%), followed by bacterial meningitis with 22 episodes (37.93%) and fungal meningitis with 6 episodes (10.34%). Etiological distribution changed significantly over the study period: viral episodes increased from 22.22% in 2023 to 77.78% in 2025, while bacterial episodes decreased from 66.67% to 22.22%. Viral meningitis predominated in children aged 1–6 years and was more frequent among male patients, whereas bacterial meningitis remained more frequent in infants. Enterovirus became the dominant identified agent in 2025. Conclusions: The local epidemiology of confirmed pediatric meningitis showed an observed redistribution among confirmed episodes toward viral etiologies, particularly enteroviral meningitis, alongside a proportional decline in bacterial episodes. These findings support continued etiological surveillance and the integration of rapid molecular testing with conventional microbiology in the diagnostic management of suspected pediatric meningitis.